Denial and Appeal Process

About Course
Conference Material (Password Required)
With the HIPAA Act of 1996, insurance companies were required to utilize the standard list of denial and remark codes when processing claims. It is up to the office to verify that denials received are appropriate and interpret remark codes to further understand the denial. This webinar will assist those just entering medical billing or those that have experience and knowledge and want to get some new ideas. Insurance companies rely a lot on computers for processing claims, so there are times when claims are denied in error. It is important to not only recognize the errors but to know what to do when these errors occur. The appeals process is a means to dispute denials and to share with the insurance company additional information not originally submitted with the claim for reconsideration. It is critical that the appeal give any and all information to the insurance carrier as to why it felt the denial is in error and to justify that with documentation. This documentation can include medical records, coding references, and coding policies. Insurance carriers are creating more policies and guidelines for procedures and services. Denials are received for incomplete claims or claims that are not submitted according to that insurance companies policies. But what can be done if the insurance company still denies the appeal? We will look at the additional options for claims when the appeal process has been exhausted and there still has not been any reimbursement.
Learning Objective:
- Understand denial and remark codes
- Identify insurance company policies
- Write an effective appeal
- Finding information regarding State insurance commissioners
- Submitting the appropriate documentation for disputing a denial
- Apply insurance company policies to your office claims
- Tracking denials for current insurance company trends
- Utilizing staff efficiently in the denials and appeals process
Areas Covered in the Session:
- Using the denial and remark code listings
- Determine who is responsible for the claim
- Realize when a claim can be corrected
- Correct assignment of modifiers
- Creating effective appeals
- Changing pre-authorizations after surgery
Suggested Attendees
- Billers
- Coders
- Administrators
- Managers
- Physicians
- Claims Adjusters
- Surgery Schedulers
- Caseworkers
- Nurses
- Reimbursement Staff
About the Presenter

Course Content
You can access all the webinar materials after successful payment
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Webinar Link + Handouts PDF
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Course Key
00:00